Lee, H., Schmidt, K., & Ernst, E. (2005). Acupuncture for the relief of cancer-related pain—A systematic review. European Journal of Pain, 9, 437–444.

To summarize a systematic review of existing evidence regarding the effect of acupuncture on cancer-related pain

Databases searched were MEDLINE, EMBASE, CINAHL, Allied and Complementary Medicine Database (AMED), PsycINFO, British Nursing Index, the Cochrane Library, and databases relative to Journal of Korean Society for Acupuncture and Moxibustion and Journal of Korean Oriental Medicine. Investigators performed manual searches of department files and the reference lists of all located articles.

Search keywords were acupuncture, electroacupuncture, cancer, neoplasm, and tumor.

Studies were included if they were

• Published in any language
• Prospective clinical studies that used manual acupuncture, ear acupuncture, or electroacupuncture for the treatment of cancer-related pain in humans.

Studies were excluded if they related to laser acupuncture, acupressure, or moxibustion or used transcutaneous electrical nerve stimulation or other cointerventions that were complementary or alternative medicine modalities; were case series, case reports, or  abstracts with no details about the intervention; and involved acupuncture for postoperative pain in patients with cancer.

Investigators reviewed 29 studies initially and chose 7 for analysis. Two authors, working independently, read all articles in full and extracted data about trial methods, study design, participants, interventions, type of pain, pain outcomes, and adverse effects. Authors used a modified Jadad scale to rate the studies. (The study summary cites rating criteria.) Authors met to reach consensus, and discrepancies were settled by discussion with the third author. The Jadad scale was modified because of the near impossibility of blinding the acupuncturist to the treatment.

• The total sample size was not reported.
• The sample range across studies was 12–92.
• Characteristics of the sample were all cancer types (heterogeneous), neuropathic nociceptive (> 30/100), abdominal, back, and not specified.

• The studies of acupuncture for cancer-related pain were not evidence-based. Visual analog scale and patient’s verbal assessment were the primary pain-related measures. One study used the plasma leucine-enkephalin level as a measure.
• The quality of the included studies was lacking—only three of the seven studies were randomized controlled trials.

Data from this study do not support the use of acupuncture as an effective analgesic adjunctive method for the treatment of cancer pain. Note that 2003 is the most recent date of an article in this systematic review; articles excluded were published 1974–2003.

Appropriately powered randomized controlled trials that investigate the efficacy of acupuncture are needed.